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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502701231
Report Date: 10/23/2024
Date Signed: 10/23/2024 11:17:04 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/21/2024 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20240621082405
FACILITY NAME:SHELTERING ARMS LLCFACILITY NUMBER:
502701231
ADMINISTRATOR:DHILLON, JATINDERFACILITY TYPE:
735
ADDRESS:3401 PUMA WAYTELEPHONE:
(209) 920-4494
CITY:CERESSTATE: CAZIP CODE:
95307
CAPACITY:4CENSUS: 3DATE:
10/23/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Sanjit Singh, Direct Support ProviderTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Staff did not prevent resident from harming other resident(s) while in care.
INVESTIGATION FINDINGS:
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On 10/23/24, Licensing Program Analyst (LPA Renee Campbell arrived unannounced regarding a complaint investigation. LPA Campbell met with Sanjit Singh, Direct Support Provider and explained the purpose of the visit.

Regarding the allegation that staff did not prevent resident from harming other residents while in care, of the eight staff, LPA Campbell conducted interviews with 3. Of the 3 residents living in the facility, LPA Campbell was able to speak with 2. Staff 1 (S1) reported that when there are physical altercations, staff will redirect, will ask residents to stop and/or will call the administrator “if things got out of hand”. S3 stated that staff are given training on redirection and defensive physical interventions and Resident 2 (R2) recounted that the police were called by staff when he was “roughhousing” with another resident. Per S3, when going out, “We try to keep them as separate as we can and allow them to choose...if they want to do it together.”

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 27-AS-20240621082405
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SHELTERING ARMS LLC
FACILITY NUMBER: 502701231
VISIT DATE: 10/23/2024
NARRATIVE
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Based on all the information collected by the Department there is not a preponderance of evidence to prove the allegation occurred, ttherefore this allegation is UNSUBSTANTIATED. Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore this allegation is unsubstantiated. Per California Code of Regulations (CCRs) - Title 22, Division 6, no deficiencies cited. Exit interview was held and a copy of report was given to Sanjit Singh, Direct Service Provider
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2